The Care Quality Commission has recommended that Colchester Hospital University Foundation Trust be placed under special measures after a recent unannounced inspection led to the regulator referring its findings to the police.
The CQC said in a report that cancer patient records were changed to ensure targets were met, resulting in the risk that care was “unsafe or not effective due to delays in receiving appointments or treatment”.
The team examined 61 cancer patient records and found 22 patients were placed at risk because they were treated at a later date than their records stated. The team also found one patient had not been given an appointment within 14 days despite being urgently referred by their GP.
Three staff members said they felt they had been “pressured, bullied or harassed” to change the dates on the cancer records to prevent a breach of the targets.
The report notes: “Staff we spoke to provided examples of bullying and harassment by the management team that had been reported in respect of changes of the cancer pathways.”
The inspection also found that staff tried to raise concerns but senior staff did not investigate. There was evidence to suggest that senior staff ordered some of the changes to the records to cover up delays in their care.
The report states: “We saw evidence in emails, minutes and letters showing that senior members of the organisation had been informed of these concerns raised by staff.”
It went on to note: “We found that the concerns raised by staff in relation to changes made to people’s cancer pathways were not appropriately managed, investigated or responded to by senior staff of the trust.”
In three instances patients’ care was delayed by over 100 days, far exceeding the 31 or 62 day treatment timeframe.
The inspection took place during August and September after the CQC was contacted by a whistleblower about concerns relating to cancer waiting times in the urology and lower gastrointestinal services.
An internal investigation in 2012 highlighted concerns but these were not acted upon.
The trust has written to 30 patients, or their next of kin where patients have died, offering to review their treatment.
The team found several examples of poor care including one patient who was seen in the lower gastrointestinal service, discharged from the service and then admitted into the emergency department shortly afterwards for surgery where it was found they had cancer.
The report said: “This person’s treatment was not provided in a manner that ensured their safety or welfare resulting in them requiring emergency treatment and potentially impacted on their health and wellbeing.”
Sean MacDonnell, Colchester’s medical director, said: “Our priority is to focus on the safety and welfare of all cancer patients.
“If there is any evidence that any of our staff have inappropriately adjusted and reported cancer figures, the Trust will take the strongest possible action against them. Equally, the trust will take action against any employee involved in bullying, harassment or coercion of its staff by other staff, if this appears to have happened in relation to changes made to data.”
The trust has announced it would be commissioning its own external investigation following the CQC’s report but would not say who was leading it. The CQC has told it to produce an action plan by 12 November and this will be followed by a further inspection.
A trust spokesman said: “The trust board is commissioning an external investigation which will look at many issues, including actions taken by senior staff in response to the whistleblowing concerns, why some staff felt they could not raise concerns internally, why the internal investigation conducted in February 2012 was so inadequate and whether staff have acted inappropriately.”
The spokesperson added: “There have not been any suspensions at this stage.”
Chief inspector of hospitals Sir Mike Richards said: “Clearly this report raises questions over the safety and effectiveness of these services. But it also raises questions at the highest level.
“We have found that the concerns raised by staff in relation to changes made to people’s cancer pathways were not appropriately managed or investigated by senior staff of the trust, which is why I am now recommending that this trust should be placed in special measures.”